Question 1

A supervisor assigns a worker a new project. The worker initially agrees but feels resentful. The next day, when asked about the project, the worker says, "I've been working on other things." When asked 4 hours later, the worker says, "Someone else was using the copier, so I couldn't finish it." The worker's behavior demonstrates:
A) acting out.
B) projection.
C) suppression.
D) passive aggression.

Accepted Answer

A passive-aggressive person deals with emotional conflict by indirectly expressing aggression toward others. Compliance on the surface masks covert resistance. Resistance is expressed through procrastination, inefficiency, and stubbornness in response to assigned tasks. Acting out refers to behavioral expression of conflict. Projection is a form of blaming. Suppression is the conscious denial of a disturbing situation or feeling.

Question 2

A person has minor physical injuries after an automobile accident. The person is unable to focus and says, "I feel like something awful is going to happen." This person has nausea, dizziness, tachycardia, and hyperventilation. What is this person's level of anxiety?
A) Mild
B) Moderate
C) Severe
D) Panic

Accepted Answer

The person whose anxiety is severe is unable to solve problems and may have a poor grasp of what is happening in the environment. Somatic symptoms such as those described are usually present. The individual with mild anxiety is only mildly uncomfortable and may even find his or her performance enhanced. The individual with moderate anxiety grasps less information about a situation and has some difficulty with problem solving. The individual in panic-level anxiety demonstrates significantly disturbed behavior and may lose touch with reality.

Question 3

Two staff nurses applied for a charge nurse position. After the promotion was announced, the nurse who was not promoted said, "The nurse manager had a headache the day I was interviewed." Which defense mechanism is evident?
A) Introjection
B) Conversion
C) Projection
D) Splitting

Accepted Answer

Projection is the hallmark of blaming, scapegoating, thinking prejudicially, and stigmatizing others. Conversion involves the unconscious transformation of anxiety into a physical symptom. Introjection involves intense, unconscious identification with another person. Splitting is the inability to integrate the positive and negative qualities of oneself or others into a cohesive image.

Question 4

A patient experiencing moderate anxiety says, "I feel undone." An appropriate response for the nurse would be:
A) "Why do you suppose you are feeling anxious?"
B) "What would you like me to do to help you?"
C) "I'm not sure I understand. Give me an example."
D) "You must get your feelings under control before we can continue."

Accepted Answer

Increased anxiety results in scattered thoughts and an inability to articulate clearly. Clarification helps the patient identify his or her thoughts and feelings. Asking the patient why he or she feels anxious is nontherapeutic, and the patient will not likely have an answer. The patient may be unable to determine what he or she would like the nurse to do to help. Telling the patient to get his or her feelings under control is a directive the patient is probably unable to accomplish.

Question 5

A person who is speaking about a contender for a significant other's affection says in a gushy, syrupy voice, "What a lovely person. That's someone I simply adore." The individual is demonstrating:
A) reaction formation.
B) repression.
C) projection.
D) denial.

Accepted Answer

Reaction formation is an unconscious mechanism that keeps unacceptable feelings out of awareness by using the opposite behavior. Instead of expressing hatred for the other person, the individual gives praise. Denial operates unconsciously to allow an anxiety-producing idea, feeling, or situation to be ignored. Projection involves unconsciously disowning an unacceptable idea, feeling, or behavior by attributing it to another. Repression involves unconsciously placing an idea, feeling, or event out of awareness.

Question 6

A patient with a mass in the left upper lobe of the lung is scheduled for a biopsy. The patient has difficulty understanding the nurse's comments and asks, "What are they going to do?" Assessment findings include a tremulous voice, respirations 28 breaths per minute, and pulse rate 110 beats per minute. What is the patient's level of anxiety?
A) Mild
B) Moderate
C) Severe
D) Panic

Accepted Answer

Moderate anxiety causes the individual to grasp less information and reduces his or her problem-solving ability to a less-than-optimal level. Mild anxiety heightens attention and enhances problem-solving abilities. Severe anxiety causes great reduction in the perceptual field. Panic-level anxiety results in disorganized behavior.

Question 7

A person who feels unattractive repeatedly says, "Although I'm not beautiful, I am smart." This is an example of:
A) repression.
B) devaluation.
C) identification.
D) compensation.

Accepted Answer

Compensation is an unconscious process that allows an individual to make up for deficits in one area by excelling in another area to raise self-esteem. Repression unconsciously puts an idea, event, or feeling out of awareness. Identification is an unconscious mechanism calling for an imitation of the mannerisms or behaviors of another. Devaluation occurs when the individual attributes negative qualities to self or to others.

Question 8

A patient experiences an episode of severe anxiety. Of these medications in the patient's medical record, which is most appropriate to administer as an as-needed (PRN) anxiolytic medication?
A) Buspirone (BuSpar)
B) Lorazepam (Ativan)
C) Amitriptyline (Elavil)
D) Desipramine (Norpramin)

Accepted Answer

Lorazepam is a benzodiazepine medication used to treat anxiety; it may be administered as needed. Buspirone is long acting and not useful as an as-needed drug. Amitriptyline and desipramine are tricyclic antidepressants and considered second- or third-line agents.

Question 9

Which assessment question would be most appropriate for the nurse to ask a patient who has possible generalized anxiety disorder (GAD)?
A) "Have you been a victim of a crime or seen someone badly injured or killed?"
B) "Do you feel especially uncomfortable in social situations involving people?"
C) "Do you repeatedly do certain things over and over again?"
D) "Do you find it difficult to control your worrying?"

Accepted Answer

Patients with GAD frequently engage in excessive worrying. They are less likely to engage in ritualistic behavior, fear social situations, or have been involved in a highly traumatic event.

Question 10

A patient in the emergency department has no physical injuries but exhibits disorganized behavior and incoherence after a minor traffic accident. In which room should the nurse place the patient?
A) Interview room furnished with a desk and two chairs
B) Small, empty storage room with no windows or furniture
C) Room with an examining table, instrument cabinets, desk, and chair
D) Nurse's office, furnished with chairs, files, magazines, and bookcases

Accepted Answer

Individuals who are experiencing severe to panic-level anxiety require a safe environment that is quiet, nonstimulating, structured, and simple. A room with a desk and two chairs provides simplicity, few objects with which the patient could cause self-harm, and a small floor space around which the patient can move. A small, empty storage room without windows or furniture would be like a jail cell. The nurse's office or a room with an examining table and instrument cabinets may be overstimulating and unsafe.

Question 11

A patient approaches the nurse and impatiently blurts out, "You've got to help me! Something terrible is happening. My heart is pounding." The nurse responds, "It's almost time for visiting hours. Let's get your hair combed." Which approach has the nurse used?
A) Bringing up an irrelevant topic
B) Responding to physical needs
C) Addressing false cognitions
D) Focusing

Accepted Answer

The patient is experiencing anxiety. The nurse has closed off patient-centered communication by changing the subject. The introduction of an irrelevant topic makes the nurse feel better. The nurse may be uncomfortable dealing with the patient's severe anxiety. The nurse has not responded to the patient's physical needs. There is no evidence of false cognition. Focusing is a therapeutic communication technique used to concentrate attention on a single issue.

Question 12

An individual experiences sexual dysfunction and blames it on a partner by calling the person unattractive and unromantic. Which defense mechanism is evident?
A) Rationalization
B) Compensation
C) Introjection
D) Regression

Accepted Answer

Rationalization involves unconsciously making excuses for one's behavior, inadequacies, or feelings. Regression involves the unconscious use of a behavior from an earlier stage of emotional development. Compensation involves making up for deficits in one area by excelling in another area. Introjection is an unconscious, intense identification with another person.

Question 13

A nurse encourages an anxious patient to talk about feelings and concerns. What is the rationale for this intervention?
A) Offering hope allays and defuses the patient's anxiety.
B) Concerns stated aloud become less overwhelming and help problem solving to begin.
C) Anxiety is reduced by focusing on and validating what is occurring in the environment.
D) Encouraging patients to explore alternatives increases the sense of control and lessens anxiety.

Accepted Answer

All principles listed are valid, but the only rationale directly related to the intervention of assisting the patient to talk about feelings and concerns is the one that states that concerns spoken aloud become less overwhelming and help problem solving to begin.

Question 14

A patient tells a nurse, "My new friend is the most perfect person one could imagine-kind, considerate, and good looking. I can't find a single flaw." This patient is demonstrating:
A) denial.
B) projection.
C) idealization.
D) compensation.

Accepted Answer

Idealization is an unconscious process that occurs when an individual attributes exaggerated positive qualities to another. Denial is an unconscious process that calls for the nurse to ignore the existence of the situation. Projection operates unconsciously and results in blaming behavior. Compensation results in the nurse unconsciously attempting to make up for a perceived weakness by emphasizing a strong point.

Question 15

Two staff nurses applied for promotion to nurse manager. Initially, the nurse not promoted had feelings of loss but then became supportive of the new manager by helping make the transition smooth and encouraging others. Which term best describes the nurse's response?
A) Altruism
B) Sublimation
C) Suppression
D) Passive aggression

Accepted Answer

Altruism is the mechanism by which an individual deals with emotional conflict by meeting the needs of others and vicariously receiving gratification from the responses of others. The nurse's reaction is conscious, not unconscious. No evidence of aggression is exhibited, and no evidence of conscious denial of the situation exists. Passive aggression occurs when an individual deals with emotional conflict by indirectly and unassertively expressing aggression toward others.

Question 16

A patient who is preparing for surgery has moderate anxiety and is unable to understand preoperative information. Which nursing intervention is appropriate?
A) Reassure the patient that all nurses are skilled in providing postoperative care.
B) Describe the procedure again in a calm manner, using simple language.
C) Tell the patient that the staff is prepared to promote recovery.
D) Encourage the patient to express feelings to his or her family.

Accepted Answer

Providing information in a calm, simple manner helps the patient grasp the important facts. Introducing extraneous topics as described in the incorrect options will further scatter the patient's attention.

Question 17

A nurse wishes to teach alternative coping strategies to a patient experiencing severe anxiety. The nurse will first need to:
A) verify the patient's learning style.
B) create outcomes and a teaching plan.
C) lower the patient's current anxiety level.
D) assess how the patient uses defense mechanisms.

Accepted Answer

A patient experiencing severe anxiety has a significantly narrowed perceptual field and difficulty attending to events in the environment. A patient experiencing severe anxiety will not learn readily. Determining preferred modes of learning, devising outcomes, and constructing teaching plans are relevant to the task but are not the priority measure. The nurse has already assessed the patient's anxiety level. Using defense mechanisms does not apply.

Question 18

A patient with a high level of motor activity runs from chair to chair and cries, "They're coming! They're coming!" The patient is unable to follow instructions or respond to verbal interventions from staff. Which nursing diagnosis has the highest priority?
A) Risk for injury
B) Self-care deficit
C) Disturbed energy field
D) Disturbed thought processes

Accepted Answer

A patient who is experiencing panic-level anxiety is at high risk for injury, related to an increase in non-goal-directed motor activity, distorted perceptions, and disordered thoughts. Existing data do not support the nursing diagnoses of self-care deficit or disturbed energy field. This patient has disturbed thought processes, but the risk for injury has a higher priority.

Question 19

A patient with a high level of motor activity runs from chair to chair and cries, "They're coming! They're coming!" The patient does not follow instructions or respond to verbal interventions from staff. The initial nursing intervention of highest priority is to:
A) provide for patient safety.
B) increase environmental stimuli.
C) respect the patient's personal space.
D) encourage the clarification of feelings.

Accepted Answer

Safety is of highest priority; the patient who is experiencing panic is at high risk for self-injury related to an increase in non-goal-directed motor activity, distorted perceptions, and disordered thoughts. The goal should be to decrease the environmental stimuli. Respecting the patient's personal space is a lower priority than safety. The clarification of feelings cannot take place until the level of anxiety is lowered.

Question 20

A patient is undergoing diagnostic tests. The patient says, "Nothing is wrong with me except a stubborn chest cold." The spouse reports that the patient smokes, coughs daily, has recently lost 15 pounds, and is easily fatigued. Which defense mechanism is the patient using?
A) Displacement
B) Regression
C) Projection
D) Denial

Accepted Answer

Denial is an unconscious blocking of threatening or painful information or feelings. Regression involves using behaviors appropriate at an earlier stage of psychosexual development. Displacement shifts feelings to a more neutral person or object. Projection attributes one's own unacceptable thoughts or feelings to another.

Quiz 11: Anxiety, Anxiety Disorders, and Obsessive-Compulsive and Related Disorders

A person has minor physical injuries after an automobile accident. The person is unable to focus and says, "I feel like something awful is going to happen." This person has nausea, dizziness, tachycardia, and hyperventilation. What is this person's level of anxiety?

Two staff nurses applied for a charge nurse position. After the promotion was announced, the nurse who was not promoted said, "The nurse manager had a headache the day I was interviewed." Which defense mechanism is evident?

A patient experiencing moderate anxiety says, "I feel undone." An appropriate response for the nurse would be:

A person who is speaking about a contender for a significant other's affection says in a gushy, syrupy voice, "What a lovely person. That's someone I simply adore." The individual is demonstrating:

A person who feels unattractive repeatedly says, "Although I'm not beautiful, I am smart." This is an example of:

A patient experiences an episode of severe anxiety. Of these medications in the patient's medical record, which is most appropriate to administer as an as-needed (PRN) anxiolytic medication?

Which assessment question would be most appropriate for the nurse to ask a patient who has possible generalized anxiety disorder (GAD) ?

A patient in the emergency department has no physical injuries but exhibits disorganized behavior and incoherence after a minor traffic accident. In which room should the nurse place the patient?

A patient approaches the nurse and impatiently blurts out, "You've got to help me! Something terrible is happening. My heart is pounding." The nurse responds, "It's almost time for visiting hours. Let's get your hair combed." Which approach has the nurse used?

An individual experiences sexual dysfunction and blames it on a partner by calling the person unattractive and unromantic. Which defense mechanism is evident?

A nurse encourages an anxious patient to talk about feelings and concerns. What is the rationale for this intervention?

A patient tells a nurse, "My new friend is the most perfect person one could imagine-kind, considerate, and good looking. I can't find a single flaw." This patient is demonstrating:

Two staff nurses applied for promotion to nurse manager. Initially, the nurse not promoted had feelings of loss but then became supportive of the new manager by helping make the transition smooth and encouraging others. Which term best describes the nurse's response?

A patient who is preparing for surgery has moderate anxiety and is unable to understand preoperative information. Which nursing intervention is appropriate?

A nurse wishes to teach alternative coping strategies to a patient experiencing severe anxiety. The nurse will first need to:

A patient with a high level of motor activity runs from chair to chair and cries, "They're coming! They're coming!" The patient is unable to follow instructions or respond to verbal interventions from staff. Which nursing diagnosis has the highest priority?

A patient with a high level of motor activity runs from chair to chair and cries, "They're coming! They're coming!" The patient does not follow instructions or respond to verbal interventions from staff. The initial nursing intervention of highest priority is to:

A patient is undergoing diagnostic tests. The patient says, "Nothing is wrong with me except a stubborn chest cold." The spouse reports that the patient smokes, coughs daily, has recently lost 15 pounds, and is easily fatigued. Which defense mechanism is the patient using?